| NPI | 1063899102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 20627) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 20627) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2020-07-08 |